Unit XII Sleep
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| Amount of life spent sleeping | one third
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| Advantages of adequate sleep | Helps cope with stress, prevent fatigue, conserves energy, restores the mind and body.
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| Characteristics of sleep | minimal physical activity, variable levels of consciousness, changes in the body's physiological process, and decreased responsiveness to external stimuli.
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| Reticular Activating System (RAS) | A network of ascending nerve fibers that are involved in the sleep/wake cycle.
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| Definition of sleep | An alternate state of consciousness in which the individual's perception of and reactions to the environment are decreased.
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| Biological rhythms in humans | Controlled by environmental factors such as light and darkness.
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| Circadian rhythm | Most familiar biological rhythm. Latin for "circa dies" meaning "about a day". A 24-hour internal biologic clock. Sleep, wake, BP, temp, etc...
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| Circadian synchronization | When a persons biological clock coincides with the sleep/wake cycles. (eg. person is awake when body temp is the highest, and asleep when it is lowest.
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| Serotonin | Neurotransmitter that is thought to lessen the response to sensory stimulation.
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| Gamma-aminobutyric acid (GABA) | Neurotransmitter that is thought to shut off the activity in the neurons of the RAS.
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| This hormone is secreted during sleep | Growth hormone (GH) is secreted and cortisol is inhibited
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| This hormone makes a person feel less alert | Melatonin is secreted from the pineal gland when a person is preparing for sleep.
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| Cortisol | Stimulating hormone
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| Non-rapid-eye-movement (NREM) | Occurs when activity in the RAS is inhibited. About 75% - 80% of sleep during the night. 3 stages.
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| Stage 1 of NREM | Very light sleep and lasts only a few minutes. Eyes roll from side to side. Drowsy and relaxed. Heart and respiratory drop slightly. Readily awakened.
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| Stage 2 of NREM | Body continues to slow down. Eyes are still. Heart and respiratory decrease slightly. Temperature falls. Requires more intense stimuli to awaken.
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| Stage 3 of NREM | Deepest stage of sleep. Essential for restoring energy and releasing GH. Heart and respiratory drop 20% - 30% lower than waking hours. Difficult to arouse. Reflexes are diminished. Not disturbed by sensory stimuli. Snoring may occur.
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| How often does Rapid-eye-movement (REM) occur? | Recurs about every 90 minutes and last 5 - 30 minutes
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| When do dreams take place? | During REM sleep. They will not be remembered unless the person arouses briefly at the end of the REM period.
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| Characteristics of REM sleep | Brain is highly active. Brain metabolism increases up to 20%. Highest levels of acetylcholine and dopamine released. Distinctive eye movements. Heart and respirations irregular.
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| Acetylcholine and dopamine | Neurotransmitters that are associated with cortical activation. Levels are high during REM; dream sleep.
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| Number of sleep cycles an adult experiences per night and how long each one lasts. | 4 - 6 cycles during 7 - 8 hours of sleep. Each cycle lasts roughly 90 - 110 minutes.
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| Physiological changes during NREM sleep | Arterial blood pressure and pulse rate decreases. Peripheral blood vessels dilate. Cardiac output and intracranial pressure decreases. Skeletal muscles relax. Basal metabolic rate decreases 10-30%. Growth Hormone levels peak.
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| Another name for deep sleep | Delta sleep. Occurs in stage 3 of NREM
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| Paradoxical Sleep | Also called REM sleep because electroencephalogram (EEG) activity resembles that of wakefulness.
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| Characteristics of sleep deprivation | Emotional irritability, poor concentration, difficulty making decisions.
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| Sleep is necessary for this. | Protein synthesis, which allows repair processes to occur.
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| What changes in sleep-rest patterns in 65-75 years old? | Go to bed approximately 1 hour earlier and awaken 1.3 hours earlier than younger adults. During sleep, they have a flattened-circadian rhythm.
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| How does daytime napping effect older adults | Contributes to reduced nocturnal sleep. After awakening at night it is difficult to fall back asleep, which results in a diminished amount of REM.
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| Sundown Syndrome | Affects clients with dementia. Not a sleep disorder directly, but it refers to a pattern of symptoms that occur in the late afternoon and can last through the night. (agitation, aggression, anxiety, delusions)
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| How respiratory conditions disturb sleep. | People with shortness of breath, nasal congestion, or sinus drainage may have trouble breathing.
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| How gastric and duodenal ulcers disturb sleep. | Increased gastric secretions occur during REM sleep.
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| Why estrogen levels disturb sleep for women. | Low levels result in fatigue and hot flashes or night sweats that cause discomfort.
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| How the environment can affect sleep. | Can promote or hinder sleep. Any change such as: hospitalization, temperature, light levels, comfort and size of bed, and a person's partner who has different sleep habits can hinder sleep.
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| Lifestyle choices that disturb sleep | Following irregular morning and nighttime schedules. Exercise late in the day. Night shift workers.
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| Lifestyle choices that promote sleep | Following regular morning and nighttime schedules. Moderate exercise in the morning or early afternoon. Wearing dark, wrap-around sunglasses after working a night shift.
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| Emotional Stress | Considered by most sleep experts to be one of the greatest causes of difficulties falling asleep or staying asleep.
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| Result of constant exposure to stress | Increases the activation of the hypothalmic-pituitary-adrenal (HPA) axis leading to sleep disorders.
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| How anxiety affects sleep | Increases norepinephrine blood levels through stimulation of the SNS, results in less deep and REM sleep and more stage changes and awakenings.
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| How caffeine disturbs sleep. | Act as a stimulant of the CNS.
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| How alcohol disturbs sleep. | Disrupts REM sleep, although it may hasten the onset of sleep. People often experience nightmares while trying to make up for lost REM.
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| How weight affects sleep. | Weight gain = reduced total sleep time, broken sleep, earlier waking. Weight loss = increase total sleep time and less broken sleep.
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| L-tryptophan | Found, for example, in cheese and milk. May induce sleep, a fact that might explain why warm milk helps some people get to sleep.
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| How Nicotine affects sleep. | Has a stimulating effect on the body. People often have more difficulty falling asleep and describe themselves as "light sleepers".
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| How medications affect sleep. | Hypnotics, narcotics, and antidepressants suppress REM sleep. Beta-blockers can cause insomnia and nightmares. Tranquilizers interfere with REM sleep.
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| Insomnia | Inability to fall asleep and remain asleep. Individuals do not awaken feeling rested. Most common sleep complaint in America.
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| Acute insomnia | Lasts one to several nights, often caused by a personal stressor or worry.
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| Chronic insomnia | Persists for longer than a month.
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| Chronic intermittent insomnia | Difficulty sleeping for a few nights, followed by a few nights of adequate sleep before the problem returns.
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| Hypersomnia | Conditions where the affected individual obtains sufficient sleep at night but still cannot stay awake during the day.
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| Narcolepsy | Disorder of excessive daytime sleepiness caused by the lack of the chemical hypocretin in the area of the CNS that regulates sleep.
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| Sleep apnea | Characterized by frequent short breathing pauses during sleep.
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| Three common types of sleep apnea | Obstructive, Central, and Mixed
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| Obstructive apnea | Occurs when structures of the pharynx or oral cavity block the flow of air. (enlarged tonsils, deviated nasal septum, nasal polyps)
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| Central apnea | Involves a defect in the respiratory center of the brain.
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| Mixed apnea | A combination of central and obstructive apnea.
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| Parasomnia | Behavior that may interfere with sleep and may even occur during sleep. Displayed as emotions, perceptions, or dreams.
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| Three classes of parasomnia's | Non-rapid eye movement, rapid eye movement, and miscellaneous with no specific stage of sleep.
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| Parasomnia's with NREM are associated with... | Confusion upon arousal, sleep tremors, and sleep walking.
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| Parasomnia's with REM are associated with... | Arousal disorders such as sleep paralysis. May be a nightmare disorder with exaggerated features of REM.
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| Miscellaneous parasomnia's may cause these problems... | Nocturnal enuresis or hallucinations. Often related to medication, substance abuse, or a medical disorder.
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| Bruxism | Clenching and grinding of the teeth during stage 2 NREM sleep.
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| Enuresis | Bed wetting during sleep can occur in children over 3 years old. Often occurs 1-2 hours after falling asleep, when rousing from stage 3 NREM sleep.
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| Periodic limb movement disorder (PLMD) | Nocturnal Myoclonus. Legs jerk twice or three times per minute during sleep. Not the same as RLS.
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| Sleeptalking | Talking during sleep occurs during NREM sleep before REM sleep.
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| Sleepwalking | Somnambulism. Occurs during stage 3 of NREM sleep. Episodic. Occurs 1-2 hours after falling asleep.
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| Restless Leg Syndrome | Occurs whenever the person is at rest, not just at night when sleeping.
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| Polysomnography | How sleep is measured objectively for sleep disorders. Includes an electroencephalogram (EEG), electromyogram (EMG), and electro-oculogram (EOG) that are corded simultaneously.
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| Electroencephalogram (EEG) | Electrodes are placed on the scalp to record brain waves.
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| Electro-oculogram (EOG) | Electrodes are placed on the outer canthus of each eye to record eye movement.
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| Electromyogram (EMG) | Electrodes are placed on the chin muscles to record the muscle structure.
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| Sleep hygiene | Interventions used to promote sleep.
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